(1) Universidade Católica de Pelotas, Pelotas, Rio Grande do Sul, Brazil.
Conlict of interest: Nonexistent
Well-being and associated factors among
elementary school teachers in southern Brazil
Mariane Lopez Molina(1)
Amanda Rodrigues Fialho(1)
Paulinia Leal do Amaral(1)
Suelen de Lima Bach(1)
Luise Marques da Rocha(1)
Luciano Dias de Mattos Souza(1)
Received on: February 10, 2017 Accepted on: September 13, 2017
Mailing address: Mariane Lopez Molina
Rua Gonçalves Chaves, 373 Prédio C, sala 411C – Centro
CEP: 96015-560 – Pelotas, RS, Brasil E-mail: mariane_lop@hotmail.com
ABSTRACT
Purpose: to verify the prevalence of well-being and its association with
sociodemo-graphic features, health and work-related conditions, and vocal behavior in elementary school teachers in the city of Pelotas, RS.
Methods: a cross-sectional observational study with 575 teachers from urban and
rural areas. The participants answered a structured questionnaire that included items on sociodemographic, health and work-related conditions. The Faces Scale (Andrews) was used to evaluate their psychological well-being. The Vocal Behavior Proile veriied
occurrences of abuse and vocal misuse. Poisson regression was used for the multiva-riate analysis.
Results: of the total sample, 79.5% of teachers experienced well-being. It was
obser-ved that vocal behavior proile was signiicantly associated with well-being, and the number of students in the classroom showed a trend towards signiicance.
Conclusion: most teachers had a satisfactory well-being perception. Moreover, a lower
well-being perception in the teaching population was mainly related to abusive vocal behavior and, less clearly, to the high number of students per classroom.
Rev. CEFAC. 2017 Nov-Dez; 19(6):812-820
INTRODUCTION
Well-being can be understood as the degree to which individuals judge the overall quality of their lives as a whole favorably. It also consists in a positive evalu-ation of somebody’s experiences in terms of affection and cognition 1,2. Most of the health studies have the
disease as the main outcome at different dimensions
3. Despite positive health outcomes, such as the
well-being construct that has been investigated in different populations 4-6, there is still signiicant lackof theoretical
consensus and measurement methods.
In this sense, the subjective evaluation of well-being
can be inluenced by several individual and social
features. Among these, the physical and psychosocial
work-related conditions have been highly associated
with physical and mental health indicators in previous studies 7,8.
Regarding the teacher population, the literature shows that adverse teaching conditions, such as high
workload, double working hours, high number of students per classroom and noise, can signiicantly
affect well-being rates and even the quality of life of these educators 9,10. Another aspect that seems to be associated with a worse work ability in teachers is the
presence of voice disorders, since voice is the teacher’s
work tool11,12.
However, it should be pointed out that the way in
which the work-related conditions affect professionals
varies from context to context, from person to person
13. Thus, speciic conditions of work organization and
physical characteristics of the school setting may not be the most important predictors when evaluating subjective health problems in teachers, such as mental health disorders 14.
While investigations on mental disorders in teachers have been presented in a clear and consistent way 15, studies focusing on the positive aspects of
health in this population are still scarce 10,16. It is
believed that addressing such aspects is relevant to
recognize subjective measures as markers of health
self-perception, and to provide data that subsidize preventive and protective actions of these professionals.
Therefore, it was hypothesized that greater well-being perceptions would be related to better physical health, including the use of the voice in teaching. In addition, more favorable organizational and demand conditions would also be associated with higher well-being rates. Therefore, the purpose of the present study was to verify the well-being prevalence and its association with sociodemographic features, health
and work-related conditions, and vocal behavior in
elementary school teachers in the city of Pelotas, RS-Brazil.
METHODS
This research was approved by the Research Ethics Committee of the Universidade Católica de Pelotas, under protocol number 2011/29. All teachers signed a written informed consent before answering the questionnaires. Those with signs of vocal impairment were referred to specialized care at the Centro de Referência em Saúde do Trabalhador.
A cross-sectional observational study was carried out at municipal schools in the urban and rural areas of the city of Pelotas. Considering the total population of 2,194 teachers from 103 municipal elementary schools and the objectives of the major research from which this study derived, the required sample number was 662, including 20% for control of confounding factors,
losses and refusals. Thus, a stratiied random sample
selection was carried out and 556 teachers from 18 urban schools and 106 teachers from 13 rural schools were selected to participate in this study.
Sample capitation was performed in the selected schools. The inclusion criteria was accepting to partic-ipate in the study, and the exclusion criteria was to be physical education (PE) teachers, as their educational characteristics differ considerably from the classroom
teachers. However, due the lack of information
regarding the number of PE teachers and/or two different registrations in the municipal service registry, a total of 633 teachers were invited to participate; 58 were considered as refusals or losses or did not answer
the evaluation tools, resulting in a inal sample of 575
teachers.
Teachers answered a self-applied structured
questionnaire, which contained questions on the following items: socio-demographic data (gender, age, socioeconomic status and education), health condi-tions (self-reported disease, tobacco use, and vocal
rest) and work (sick leave due to voice, teaching time, workload, overtime, number of students per classroom
and the school grades).
Well-being assessment was performed using the Andrews Faces Scale 17. It is a visual scale composed
unhappy”). Therefore, the lower the score, the greater the degree of well-being perceived by the interviewee.
As an outcome of this work, responses 1, 2 and 3 were
considered as well-being 3.
Socioeconomic status was measured using the
classiication proposed by the Brazilian Economic
Indicator (Indicador Econômico Nacional - IEN) based on the 2000 Demographic Census 18. The sample was
divided into tertiles and placed into lower, middle or upper economic classes.
Teachers vocal behavior was veriied by the Vocal Behavior Proile 19, composed of 28 questions was
developed to identify situations of abuse and vocal misuse as well as adverse conditions for vocal health. The score was determined as follows: 0 point indicates never, 1 point rare occurrence, 2 points low frequency, 3 points high occurrence and 4 points constant occur-rence. Through the sum of the total score, the vocal
proile was classiied as “behaved/candidate for vocal problems” (≥30 points), “serious risk” (from 31 to 50 points), and “champion of abuses” (≥51 points).
The data were typed twice, with subsequent review
to verify possible failures in illing, including automatic checks for consistency and amplitude by the Epi-Info™
6.04. Data analysis was performed in the SPSS 22.0
software. Relative and absolute frequencies of the variables were described in the univariate analysis. Chi-square test was used in the bivariate analysis, aiming to describe associations between well-being and the independent variables. Finally, multivariate analysis was performed by Poisson regression 20.
The study variables that obtained p≤0.20 in the
bivariate analysis were divided into two hierarchical
models: the irst level composed of demographic variables (socioeconomic status) and working condi -tions (school location, the school grades), number of students per classroom); in the second level, the variables of health conditions (self-reported disease and tobacco use) and vocal behavior (voice behavior
proile and sick leave due to voice).21 Signiicance levels
were set at p <0.05.
RESULTS
In the present study, females were more prevalent (91.3%), with up to 40 years of age (50.3%) and from middle class (35%). Concerning education, 51.2% of the teachers had a postgraduate degree. For health-related conditions, 71.6% of teachers had some
Rev. CEFAC. 2017 Nov-Dez; 19(6):812-820
Table 1. Association of well-being with characteristics and health conditions of elementary school teachers in Pelotas, RS, Brazil, 2011 (n = 575)
Variable Total
n (%)
Well-being
n (%) p-value*
Gender 0.930
Female 525 (91.3) 418 (79.6)
Male 50 (8.7) 39 (78.0)
Age (years)** 0.315
Up to 40 279 (50.3) 226 (81.0)
41 or more 276 (49.7) 213 (77.2)
Economic status** 0.129
Lower 173 (33.3) 132 (76.3)
Middle 182 (35.0) 143 (78.6)
Upper 165 (31.7) 137 (83.0)
Education** 0.670
High school 43 (7.5) 34 (79.1)
Graduate 237 (41.3) 186 (78.5)
Post-graduate 294 (51.2) 236 (80.3)
Self-reported disease** 0.009
No 155 (28.4) 135 (87.1)
Yes 391 (71.6) 300 (76.7)
Tobacco use** 0.020
Never 413 (73.5) 333 (80.6)
Past 82 (14.6) 70 (85.4)
Current 67 (11.9) 43 (64.2)
* Chi-square test; ** Variable with loss.
Regarding work-related conditions, most of teachers worked in urban schools (75.8%), had up to 10 years of teaching (47.2%), had a weekly workload of between 21 and 40 hours (62.7%) and did not work overtime
(78.3%). The majority taught between 1st and 4th grades
(66.7%) and had up to 25 students per classroom
(75.9%). Concerning the vocal behavior proile, 49.2%
of the sample was considered champion of vocal abuses, 67.6% reported no vocal rest, and 15% needed
to take sick leave due to voice problems (Table 2).
The prevalence of well-being among teachers was 79.5%. They pointed at one of the three happier faces. In the bivariate analysis, the well-being perception was more prevalent in those who reported not having any disease (p=0.009). In addition, for those who reported
a current smoking habit, the well-being prevalence was signiicantly lower (p=0.020) (Table 1).
For the association of well-being with work-related
conditions, a higher prevalence was observed in teachers who had fewer students per classroom (p=0.012). Regarding vocal behavior, those teachers
classiied as champions of vocal abuses presented
worse well-being perception, compared to the other categories (p=0.005). In addition, those who did not
take sick leave due to voice problems had a higher
prevalence of well-being (p=0.048) (Table 2).
In the multivariate analysis, the only variable that
remained signiicantly associated with well-being was the vocal behavior proile, with a 20% higher risk
Table 2. Association of well-being with work conditions and vocal behavior of elementary school teachers in Pelotas, RS, Brazil, 2011 (n = 575)
Variable Total
n (%)
Well-being
n (%) p-value*
School location 0.150
Urban 436 (75.8) 353 (81.0)
Rural 139 (24.2) 104 (74.8)
Teaching time (years)** 0.677
Up to 10 269 (47.2) 214 (79.6)
11 to 20 142 (24.9) 117 (82.4)
21 or more 159 (27.9) 123 (77.4)
Working hours** 0.235
Up to 20 124 (21.6) 101 (81.5)
21 to 40 359 (62.7) 287 (79.9)
41 or more 90 (15.7) 67 (74.4)
Overtime** 0.880
No 445 (78.3) 356 (80.0)
Yes 123 (21.7) 97 (78.9)
Teaches 1st to 4th grades** 0.059
No 190 (33.3) 142 (74.7)
Yes 381 (66.7) 312 (81.9)
Students per classroom** 0.012
Up to 25 422 (75.9) 344 (81.5)
26 or more 134 (24.1) 95 (70.9)
Vocal behavior proile** 0.005
Behaved or candidate for vocal problems 52 (10.4) 44 (84.6)
Serious risk for vocal problems 203 (40.4) 172 (84.7)
Champion of vocal abuses 247 (49.2) 181 (73.3)
Does vocal rest** 0.546
No 388 (67.6) 305 (78.6)
Yes 186 (32.4) 151 (81.2)
Sick leave due to voice problems** 0.048
No 488 (85.0) 395 (80.9)
Yes 86 (15.0) 61 (70.9)
Rev. CEFAC. 2017 Nov-Dez; 19(6):812-820
DISCUSSION
The present research found a high prevalence of well-being among elementary school teachers. It was also possible to verify that greater well-being perception was present among the teachers who presented a
proile of vocal behavior characterized by better use of
voice. In addition, a trend towards greater well-being was observed among teachers who taught in classes with fewer students.
The present cross-sectional study contains an important limitation that includes the impossibility of establishing a causal association between the exposures and the outcome, as well as indicating the direction of the observed association and the temporal sequence of events. The main strengths are the use of analogical-visual scales such as faces, that have
provided a more direct representation of feelings, when compared to the verbal translation necessary to answer a question on this subject 17, and the large sample of
elementary public school teachers who participated in this research.
The prevalence of well-being among elementary school teachers was 79.5%, indicating that they evaluated their own lives in a positive way. Investigations on the levels of well-being and possible associated factors in different populations are scarce in the inter-national literature and almost nonexistent in Brazil4.
Comparing the well-being prevalence of teachers inter-viewed (79.5%) to the adolescent population, using the same method of measurement, the proportion of well-being observed was higher in the group of young-sters (85.3 and 89.6%) 5,22. Sociocultural characteristics
related to the different age groups investigated may
Table 3. Poisson regression indicating associated factors with well-being in elementary school teachers in Pelotas, 2011 (n = 575)
Variable RR (CI95%) p-value
1st Level
Economic status 0.141
Lower Reference
Middle 1.03 (0.92 - 1.15)
Upper 1.09 (0.98 - 1.23)
School location 0.111
Urban Reference
Rural 0.90 (0.80 – 1.02)
Teaches 1st to 4th grades 0.173
No Reference
Yes 1.07 (0.97 - 1.19)
Students per classroom 0.076
Up to 25 Reference
26 or more 0.90 (0.80 - 1.01)
2nd Level
Self-reported disease 0.127
No Reference
Yes 0.93 (0.84 - 1.02)
Tobacco use 0.146
Never Reference
Past 1.05 (0.94 - 119)
Current 0.84 (0.69 - 1.01)
Vocal behavior proile <0.001
Behaved or candidate for vocal problems Reference Serious risk for vocal problems 0.95 (0.82 - 1.08)
Champion of vocal abuses 0.80 (0.69 - 0.93)
Sick leave due to voice problems 0.227
No Reference
Yes 0.90 (0.76 - 1.06)
explain the small difference, since a lower well-being perception was related to perceived age-related loss of the human development cycle 23. In adolescence,
performance scores related to quality of life are higher than in adult life 24.
Conversely, Kidger et al. 16 found in their research in
the United Kingdom low scores of well-being perception
speciically among teachers. It is possible that such
a difference, of higher well-being scores among the
Brazilian population, is inluenced by speciic socio -cultural characteristics of the country, since the well-being perception varies according to regional and socioeconomic characteristics 25. Although the Brazilian sample was exposed to unfavorable working-related
conditions 26, most teachers had a favorable perception,
which can be explained by factors, such as being
satisied with their work, social support and good
coping strategies, important aspects that guarantee the general well-being of people 27.
Regarding the work-related conditions, the teachers
with more than 25 students in the classroom had a lower proportion of well-being. Other studies have shown a similar association between well-being and
the characteristics of the teaching work. The number of
students per classroom was correlated to the burnout scores in the study of Carlotto and Palazzo (2006) 28.
In turn, Kidger et al.16 observed that lower well-being was associated with working in schools with higher requirement for tasks and performance.
In a qualitative study conducted with university professors from Iraq, more interactive educational practices were implemented and the number of students per classroom was reduced 29. This has
resulted in positive reports of experience and perfor-mance by teachers, despite challenges related to poor
infrastructure and lack of resources. These indings
may justify the tendency toward the association between well-being with lower number of students per
classroom. Also, it may be inferred that task overload and the lack of adequate teaching methodologies can impair the sense of self-eficacy and result in worse
subjective assessments of well-being among teachers. In addition, although the p-value found is higher than 0.05, the interpretation of the result indicates that the difference in well-being prevalence observed is less
than 8% more likely to be explained by chance.
Although other studies contemplate the relationship of vocal symptoms with the emotional scope of teachers
30, with the capacity to perform activities at work 11,12, and with psychosocial and work organizational charac -teristics 31, the present study is a pioneer in the ield
by presenting the association between vocal behavior
proile and well-being in teachers. A higher proportion
of well-being perception was observed among teachers who reported good vocal behaviors or presented lower
risk of vocal problems. Usually, literature presents an
association between emotional and vocal problems
32,33, however, this new inding suggests that well-being
may contribute to the use of more assertive coping strategies focused on occupational problems, such as better use of voice in the classroom 34.
This suggestion should be interpreted with caution due the research design. However, in a longitudinal study, it was observed that the presence of mental
disorders is a risk factor for incidence of vocal problems 35. The presence of mental disorders is commonly
associated with a lower proportion of wellbeing 36 and
dysfunctional coping strategies 37, and may contribute
to poor voice use 34. Emphasis is placed on the need to understand the factors that protect workers’ health,
so that preventive and protective strategies can be considered based on the individual abilities. We also
emphasize the paucity of speciic research on positive
aspects of health, considering that this gap in the
scien-tiic literature lacks consensus and discussion.
CONCLUSION
Based on the results obtained, we conclude that most elementary school teachers have a satisfactory sense of well-being. Moreover, the lower well-being perception in the teaching population is mainly related to abusive vocal behavior and, less clearly, to the high number of students per classroom.
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